Pemicu 2“Mulutku tidak bisa dibuka”

JESLY CHARLIES, 405100171

Kelompok 14_Blok Sistem Respirasi

Learning Objectives

1. Menjelaskan anatomi faring, laring dan kepala leher; struktur yang ada di dalamnya; dan hubungannya.

2. Menjelaskan kelainan di nasofaring.3. Menjelaskan kelainan di orofaring.4. Menjelaskan kelainan di laringofaring.5. Menjelaskan kelainan di kepala leher.

LO 2-5 Definisi, etiologi, faktor risko & predisposisi,

patofisiologi, klasifikasi, gejala dan tanda klinis, diagnosis & pemeriksaan, diagnosa banding, tatalaksana, komplikasi, prognosis.

LO1.

Menjelaskan anatomi faring, laring dan kepala leher; struktur yang ada di dalamnya; dan hubungannya.

Pharynx

Adalah saluran pernapasan (dan pencernaan) bagian atas, terletak di belakang hidung, rongga mulut, dan larynx.

Batas Superior : basis cranii Inferior :

Anterior : pinggir inferior cartilago cricoidea Posterior : pinggir inferior vertebra C6

Pharynx dibagi 3:NasopharynxOropharynxLaryngopharyx

1. Nasopharynx

Batas-batas Anterior : choanaSuperoposterior : permukaan inferior

corpus os sphenoidalis dan pars basilaris os occipitalis

Inferior : palatum molle Ada 5 saluran : 2 tuba eustachius, 2

choana, pintu ke oropharynx Terdapat tonsilla pharyngealis

2. Oropharynx

Batas-batasAnterior : faucium (isthmus

oropharyngeal)Superior : palatum molleInferior : epiglottis

Terdapat :Tonsilla palatina 2 buahTonsilla lingualis

3. Laryngopharynx

Bagian dr saluran pencernaan dan pernapasan

Batas-batasSuperior : epiglottisInferior :

Anterior : pinggir inferior cartilago cricoidea

Posterior : pinggir vertebra C6

Berhubungan dg larynx melalui aditus laryngeus

Larynx

Larynx kompleks organ yg berfungsi memproduksi suara, terletak di leher depan setinggi vertebrae C3-C6, menghub laryngopharynx dg trachea

Fungsi :Sbg katup yg menjaga agar tractus

respiratorius tdk kemasukan makanan sewaktu menelan

Pengatur banyaknya udara yg masuk sesuai dg berbagai keaktifan

Vokalisasi

Rangka pembentuk larynx Cartilago thyroidea terbesar, cartilago hyaline, ♂ > ♀, tdr ats

2 lamina yg bsatu di anterior membentuk prominencia laryngea (adam’s apple), yg lbh menonjol pd pria

Cartilago cricoidea bbtk cincin stempel, bag anterior > rendah = arcus, bag posterior > tggi = lamina

Epiglotis cartilago elastin bbtk spt daun, bersifat elastis, tltak di posterior radix lingua& os hyoideum, dianterior aditus laryngeus, bgrak membuka/menutup aditus laryngeus ketika menelan makanan

Cartilago arytoneidea (2) bbtuk segitiga, tltak datas lamina cartilago cricoidea, berperan dlm pmbtkan suara

Cartilago corniculata (2) menempel pd apex cartilago arytenoidea, muncul sbg nodul kcl di bag posterior plica arypiglittica, menyokong struktur epiglotis

Cartilago cuneiformis (2) tltak didepan cartilago corniculata, muncul sbg nodul kecil di bag posterior plica arypiglottica, tdk meempel/berhub dg cartilago lain, menyokong struktur epiglotis

LO2.

Menjelaskan kelainan di nasofaring.

Cincin Waldeyer terdiri atas susunan kelenjar limfe yg terdapat di nasofaring dan orofaring yaitu:tonsil faringeal (adenoid)tonsil palatinatonsil lingualtonsil tuba Eustachius (tonsil tubaria)

Adenoid

Adenoid produce B cells give rise to IgG & IgA.

Serve as immunological memory in younger children.

The adenoid may be implicated in upper respiratory tract disease due to partial or complete obstruction of the nasal choanae or as a result of sepsis.

Clinical Grading of Adenoid Size (Clemens et al.)

Grade Description

Grade I Adenoid tissue filling one-third of the vertical portion of the choanae

Grade II Adenoid tissue filling one-third to two-thirds of the choanae

Grade III From two-thirds to nearly complete obstruction of the choanae

Grade IV Complete choanal obstruction

Adenoid Hypertrophy

Adenoid Hypertrophy

Pertumbuhan berlebih dari jaringan limfoid sekitar umur 3 sampai 8 tahun dapat menunjukkan gejala seperti: Snoring (mendengkur) Mouth breathing Apnea Dysphagia

Mungkin mempunyai riwayat: Snorting (mendengus) Gasping (terengah-engah) Hyponasal speech Restless sleep Enuresis (ngompol) Growth disturbance Failure to thrive

Adenoid Hypertrophy

PF tonsilar hypertrophy Endoscopy or lateral soft tissues

radiographs adenoid hypertrophy Lymphoid hypertrophy and relaxation

of the pharyngeal musculature during sleep increases the obstruction

Children craniofacial anomalies / neuromuscular disorders

Causing:FeverSore throatOdynophagia (painful swallowing)MalaiseOropharyngeal erythemaEdemaExudatesRash or lymphadenopathy

Tonsillectomy/Adenoidectomy

Indication of Tonsillectomy +/- Adenoidectomy

Absolute indications

Upper airway obstruction

Severe dysphagia

Cardiopulmonary complication

Unresponsive or recurrent peritonsillar abscess

Tonsillitis with febrile convulsions

Biopsy needed for tissue pathology

Relative indications

3 or more tonsillar infections per year despite proper medical treatment

Persistent foul taste or halitosis

Chronic or recurrent tonsillitis in a streptococcal carrier unresponsive to medical management

Unilateral tonsillar hypertrophy presumed to be of neoplastic origin

Complications of Adenoidectomy Bleeding Dental trauma Airway obstruction (retained swab,

nasopharyngeal blood clot) Infection Cervical spine injury Velopharyngeal dysfunction Regrowth of adenoid

LO3.

Menjelaskan kelainan di orofaring.

Acute Pharyngitis

Acute pharyngitis: common inflammation of the pharynx and tonsils.

Gejala utama acute onset sore throat

Etiology of Pharyngitis

Bacterial• Group A β-hemolytic Streptococcus (GABHS)• Group C and G β-hemolytic Streptococcus• Arcanobacterium hemolyticum• Neisseria gonorrhoeae• Mycoplasma pneumoniae• Chlamydia pneumoniae• Corynebacterium diphtheriae

Viral• Rhinovirus• Corona virus• Influenza virus• Respiratory syncytial virus• Parainfluenza virus• Epstein – Barr virus• Human immunodeficiency virus

Fungal• Candida albicans

Pathophysiology

Bacteria or viruses may directly invade the pharyngeal mucosa local inflammatory response.

Rhinovirus irritation of pharyngeal mucosa secondary to nasal secretion.

Streptococcal infections local invasion and release of extracellular toxins and proteases.

Tonsillitis

The causative organism in acute suppurative tonsillitis is GABHS.

Diagnosis, based on a history of:Pyrexial illnessSore throat with a painful swallowPharyngeal erythema with or without

tonsillar exudates and painful cervical adenopathy

Diagnosis of Causative Agent Bacteriological culture of a throat

swab (+) culture for GABHS Rapid Antigen Testing (RAT)

Complication of acute tonsillitis Systemic sepsis septicaemia, septic

arthritis GABHS acute exanthematous reaction

with a macular rash scarlet fever Noninfective sequelae of GABHS

rheumatic fever and glomerulonephritis (under Immunocomplex disorders)

Peritonsillar abscess (Quinsy) Retropharyngeal abscess Parapharyngeal abscess Lemierre’s syndrome

Peritonsillar Abscess (quinsy) Peritonsillar Abscess a collection of pus forms in the

potential space between the tonsil and its bed Anaerobic organism and GABHS Presentation:

Severe pharyngitis Servere trismus Airway compromise and dehydration Progressive Unilateral Dysphagia Trismus Drooling of saliva Ipsilateral lymphadenopathy Odynophagia Ipsilateral otalgia Enlarged jugulodigastric node

Peritonsillar Space Infections Komplikasi dr tonsillitis Gambaran klinis:

Merah Tonsil bengkak bilateral, biasanya eksudat Pembengkakan signifikan di lateral dan superior tonsil

pada 1 sisi Kasus berat uvula displaced krn efek dr adanya masa Nyeri saat membuka mulut jika infeksi dan inflamasi

meluas ke M.pterygoid internal di parapharyngeal space

Serious peritonsillar space infections severe cellulitis and abscess

Nyeri saat membuka mulut ada abses Tidak nyeri saat membuka mulut tdk ada abses

Strep viridans , Stap aureus, H influenzae

Risk of aspiration use of local anesthesia prior to incision exacerbates this risk

Treatment high dose penicillin IV or cephalosporin, erythromicin, incision and drainage

Retropharyngeal abscess

S.viridans , S.aureus Treatment high dose AB + urgent

incision and drainage fever, irritability, lymphadenopathy,

poor oral intake, sore throat, drooling pain, dysphagia, snoring, nasal

obstruction, Dyspnea and respiratory distress Lateral posterior oropharyngeal wall

bulge

Retropharyngeal Space Infections Gejala klinis:

DemamDisfagiaIrritabilityMuffled (teredam) cry or speechTorticollisStertorDrooling and stridor kasus berat

Parapharyngeal abscess

Klebsiella pneumoniae, streptococcus viridans

Treatment penicillin, broad spectrum AB IV, aspiration

Patient usually severely systemically unwell, with severe trismus and possibly airways compromise

Recurrent streptococcal tonsillitis is diagnosed when an individual has 7 culture-proven episodes in 1 year, 5 infections in 2 consecutive years, or 3 infections each year for 3 years consecutively.

Individuals with chronic tonsillitis may present with chronic sore throat,halitosis, tonsillitis, and persistent tender cervical nodes.

Individuals with peritonsillar abscess (PTA) present with severe throat pain, fever, drooling, foul breath, trismus (difficulty opening the mouth), and altered voice quality (the "hot potato" voice).

Etiology

HSVEBVCytomegalovirusOther herpes virusesAdenovirusMeasles virusGABHSS pyogenesNeisseria gonorrheaS penumonia, Stap aureus, H influenzae

(recurrent)Bacteroides fragilis (anaerob recurrent tonsillitis)

Diagnosis

Rapid antigen testing of a throat swab for GABHS

Bacterial culture Clinical assessment

Treatment

Supportive analgesics and adequate hydration

Antibiotic benzylpenicillin (if theres no sign of improvement within 48-72 hours or in whom there is clinical concern because of the severity of symptoms)

TONSILITIS AKUT

GEJALA PEMERIKSAAN TERAPI

Tonsilitis viral Menyerupai common cold disertai rasa nyeri

tenggorokan

Rongga mulut tampak luka kecil pada

palatum dan tonsil yang sangat nyeri dirasakan pasien

Istrahat, minum cukup, analgetika

dan antivirus di beri jika gejala berat

Tonsilitis bakterial

Nyeri tenggorokan dan telan, demam, lesu,

rasa nyeri sendi, tidak nafsu makan

Tonsil membangkak, hiperemis dan kelenjar

submandibula membengkak dan

nyeri telan

Antibiotika spektrum lebar penisilin,

eritomisin, antipiretik dan obat kumur

mengandung desinfektan

TONSILITIS KRONIK GEJALA PEMERIKSAAN TERAPI

Fk predisposisinya : rangsangan menahun dr

rokok, beberapa jenis makanan, higiene mulut

yang buruk,pengaruh cuaca.

Rasa ganjalan di tenggorokan,

tenggorokan kering dan nafas berbau

Tonsil membesar dgn permukaan

tidak rata, kriptus melebar

Obat kumur dan obat isap

TONSILITIS MEMBRANOSA

GEJALA DAN TANDA PEMERIKSAAN TERAPI

Tonsilitis difteri

Nyeri kepala, suhu tubuh subfebris, tidak nafsu makan, badan lemah, nadi lambat,

nyeri telan

____ Anti difteri serum (ADS),

antibiotika, kortikosteroid

Tonsilitis septikPenyebab : streptokokus hemolitikus terdapat dalam susu sapi sehingga dapat timbul epidemi

Diphteria

Coryneabacterium diphteriae (three strains: gravis, intermedius, mitis)

Affecting young children Symptoms pharyngitis with sore throat

and malaise, feverish, development of charateristic grey pseudomembrane over the surface (consist of necrotic tssue, bacteria, dan rich fibrinous exudate) early removal causes bleeding

Endotoxin can cause a toxic myocarditis in the second week of the disease

Treatment high dose benzylpenicillin and antitoxin

Airway management removal of laryngeal membrane, administration of oxygen and humudification, and endotracheal intubation or tracheostomy

LO4.

Menjelaskan kelainan di laringofaring.

Acute Epiglottitis (Supraglottitis) Most common causes Haemophilus

influenza type B Toxic child with a short history of sore

throat, inspiratory stridor, muffled voice, and drooling due to odynophagia and dysphagia

Febrile, tachypnoeic and traditionally will be sitting upright, with the neck extended to optimize the airway, and using arms to provide support to the shoulder girdle to respiration

Secure airway with endotracheal intubation

LO5.

Menjelaskan kelainan di kepala leher.

Suppurative parotitis Suppurative cervical adenitis